Seeing the Light

What does it feel like to know progress has been made with someone you are working with? Small teeny windows have opened, and there is a light on that before did not exist? How do you know that a shift has occurred?

I have a patient I have been working with for years. She again, objectively appears to be flourishing. She left a high powered job in the corporate world to go to graduate school, a lifelong dream. Yet, she continues to be a hostage.

I have rarely worked with someone with such a sophisticated defense structure.

We have had ebbs and flows over the years, but never really making huge progress. She is so bright and her ED is so entrenched that it is like hand to hand combat.

She shuts me down at every turn, every suggestion, every option, is met with indifference, dismissal and disdain. She is consumed with physical perfection, with an attachment to being  invincible, beautiful and effortless-above all-brilliant.

But again, we know what humans really are.

Human beings are none of those things.

We are filled with doubts and fears. We are afraid of being alone, we know that there are parts within us that feel like a small child wanting approval, recognition or a hug and unconditional love.

To have an eating disorder is to disavow this part. To shame it, to not allow it room to breathe or be seen. But this brutal dismissal of our childlike part does not make it “go away”, it buries it. It still lives within us, wanting to be seen and cared for- but now it feels shamed. Even more afraid to make itself known.

This burial of vulnerability can come across as narcissism. Egomaniacal, cold and indifferent.

So this person I have worked with for years had this inner child so buried, so hidden that they were inaccessible. We got to the point in one of our sessions a year or so ago when I said, I realize that whatever I say will be met with rejection, and combat.

I said, “I don’t feel like arguing with your ED, and pushing you to let a different reality in the room- I don’t think it’s working. In some ways I think your ED is enjoying the battle. Perhaps, I just need to be quiet and go through this with you? Maybe we don’t need to reality-test all the time and I can just sit here and witness the brutality of the war inside your mind?”.

There was a small imperceptible shift after that.

There was silence.

There was no hardened retort or response, just the word “maybe”.

That was the first tiny shift.

After that session I worked less around fighting and really just listened, I pointed out some inconsistencies, but for the most part I let her go. I let her talk about her sadness her feelings of worthlessness, her self-hatred and revulsion.

My perspective was unwavering, “that is such a hard version of yourself to believe is real”, I would say, “it is so different from what I see”. 

She would pause therapy due to her schedule but like clockwork, after a month or two hiatus, I would get a text “Hi Dr. Shelov- do you have any time over the next few weeks? I can be flexible”?

We would cobble together times that worked for us, resume as if no time had passed, but recently I am feeling the light sneaking in through the cracks. There is a sense that she is hearing me. She is not rejecting what I have to say.

In the words of Viktor Frankl “Between stimulus and response there is a space.  In that space is our power to choose our response. In our response lies our growth and our freedom”.

Through time, patience, perseverance and maturity, this young woman was starting to question her own inner ED. She was not simply along for the ride, but beginning to change herself in order to change her experience.

In one of our most recent sessions she said to me “I know this sounds crazy, but tell me what I should do? What should I eat tomorrow that is “normal’”.

Now we have had that exact conversation countless times over the past 10 years, but the tenor of the question was entirely different. There was an openness and an innocence in the question. I felt the presence of a young girl tentatively asking me for help without fear of being rejected or shamed.

I answered her with compassion, and certainty. I validated her question, and told her how grateful I was that she had the courage to ask it.

I have no illusion that this battle is won, but the lights are turning on. There is hope in the room, and I am gently pushing, and mostly bearing witness.